The value imperative

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 - Lisa Fratt - Portrait
Lisa Fratt, Editor

Certain imperatives are occasionally drowned out in the clamor about healthcare spending and funding. Take, for example, the need for improved value. If we could squeeze additional value out of our healthcare spending, the U.S. might mitigate some of its woes. Several studies published this week underscored the point.

The National Lung Screening Trial released first-round results May 23 in the New England Journal of Medicine. More than twice as many early-stage lung cancers were diagnosed in the CT cohort than in the chest x-ray cohort. The researchers acknowledged that participants in the CT arm underwent more follow-up procedures, which represent additional costs.

However, early-stage lung cancers are by and large curable. That means the costs of detecting, diagnosing and treating these patients can be viewed as a cost shift from the spending required to diagnose and treat later-stage lung cancers, which have an abysmal five-year survival rate. Low-dose CT screening is a good value, which is one reason a number of organizations have committed to free screening programs in the absence of reimbursement.

In contrast, some frequently employed treatments deliver little value. Postprostatectomy IMRT falls into this category, according to a study published online May 20 in JAMA Internal Medicine. With a reimbursement rate nearly double that of conformal radiation therapy (CRT), IMRT has nearly replaced CRT.

In some cases, the use of IMRT is justified as research has demonstrated reduced morbidities and improved cancer control. However, the need for fine-tuned treatment to better target radiation dose may be lower among postprostatectomy patients.

A review of the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database demonstrated the point. There were no differences in significant morbidities or disease recurrence by CRT or IMRT among postprostatectomy patients.

The finding “is broadly illustrative of a difficulty in health care in which new technologies are rapidly adopted before evidence of clinical superiority,” the researchers wrote.

The value issue cuts a wide swath.

Cancer patients were 2.65 times more likely to go bankrupt than those without cancer, researchers reported in the May issue of Health Affairs. The authors described bankruptcy as a lose-lose dilemma for debtors and creditors.

They proposed one strategy to address the problem: tax incentives to encourage employers to offer supplemental insurance to cover costs in the first year after a cancer diagnosis. The authors also encouraged oncology providers to assess the financial health of their patients. Both practices may deliver value.

What are your practice’s value pain points? How are you addressing them? Please share.

Enjoy the holiday weekend.

Lisa Fratt, editor